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The prevalence of ulcerated plaques in the aortic arch in patients with stroke
P Amarenco1, C Duyckaerts, C Tzourio
1Laboratoire de Neuropathologie R. Escourolle, Hôpital de la Salpêtrière, Paris, France.
Insights
Ulcerated plaques in the aortic arch are more common in patients with cerebrovascular disease, particularly those with unexplained cerebral infarction. These findings suggest a potential link between aortic plaques and stroke formation.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pathology
Background:
- The etiology of cerebral infarction remains unknown in a significant portion of patients.
- Investigating potential sources of cerebral emboli is crucial for understanding stroke.
- The aortic arch is a potential source of emboli contributing to cerebrovascular events.
Purpose of the Study:
- To determine the frequency of ulcerated plaques in the aortic arch.
- To explore the association between aortic arch ulcerated plaques and cerebral infarction.
- To identify risk factors for cryptogenic cerebral infarction.
Main Methods:
- Retrospective autopsy study of 500 consecutive patients with cerebrovascular and other neurologic diseases.
- Analysis of the prevalence of ulcerated plaques in the aortic arch.
- Statistical control for covariates such as age and heart weight.
Main Results:
- Ulcerated plaques were found in 26% of cerebrovascular disease patients versus 5% of controls (P < 0.001).
- Adjusted odds ratio for ulcerated plaques in cerebrovascular disease was 4.0 (95% CI, 2.1-7.8).
- Prevalence was significantly higher (61% vs 22%, P < 0.001) in patients with unexplained cerebral infarction compared to those with a known cause.
Conclusions:
- Ulcerated plaques in the aortic arch are a significant finding in patients with cerebrovascular disease.
- These plaques may contribute to the pathogenesis of cerebral infarction, especially in cryptogenic cases.
- Aortic arch ulcerated plaques represent an independent risk factor for stroke.
Background And Methods:
The cause of cerebral infarction is obscure in up to 40 percent of patients with this disorder who are studied prospectively. In this investigation, we determined the frequency of ulcerated plaques in the aortic arch and explored the part they may play in the formation of cerebral emboli. Using an autopsy data bank, we studied the prevalence of ulcerated plaques in the aortic arch in 500 consecutive patients with cerebrovascular and other neurologic diseases who were studied at autopsy.
Results:
Ulcerated plaques were present in 26 percent of the 239 patients with cerebrovascular disease but in only 5 percent of the 261 patients with other neurologic diseases (P less than 0.001). After we controlled for age and heart weight, the adjusted rates were 16.9 percent and 5.1 percent, respectively (adjusted odds ratio, 4.0; 95 percent confidence interval, 2.1 to 7.8; P less than 0.001). Among the patients with cerebrovascular disease, the prevalence of ulcerated plaques in the aortic arch was 28 percent in the 183 patients with cerebral infarcts and 20 percent in the 56 patients with brain hemorrhage. The prevalence of ulcerated plaques was 61 percent among the 28 patients with no known cause of cerebral infarction, as compared with 22 percent among the 155 patients with a known cause of cerebral infarction (P less than 0.001). After adjustment for covariates, the prevalence was 57.8 percent among patients with no known cause of cerebral infarction and 20.2 percent among those with a known cause (adjusted odds ratio, 5.7; 95 percent confidence interval, 2.4 to 13.6; P less than 0.001). The presence of ulcerated plaques in the aortic arch was not correlated with the presence of extracranial internal-carotid artery stenosis, suggesting that these were two independent risk factors for stroke.
Conclusions:
Ulcerated plaques in the aortic arch may play a part in causing cerebral infarction, especially in patients in whom cerebral infarction has no known cause.